Protocolos de Parada Cardiorrespiratória na Sala de Emergência: Uma Revisão Sistemática

Cardiopulmonary arrest (CPA) is a medical emergency that requires immediate and effective intervention in the emergency room. Well-defined protocols are essential to optimize patient outcomes. A systematic review was conducted following PRISMA guidelines. Comprehensive literature search included electronic databases and relevant references. Studies addressing CPA protocols in the emergency room were included, with assessment of methodological quality and data extraction. Analysis of included studies revealed a variety of approaches in CPA protocols, highlighting both points of agreement and disagreement among international guidelines. Integration of resuscitation strategies, such as post-CPA temperature management and acute coronary syndromes, was discussed in relation to challenges and opportunities in clinical practice. This systematic review provides a comprehensive synthesis of current evidence on CPA protocols in the emergency room, emphasizing the importance of implementing updated guidelines and identifying gaps to guide future research and improvements in clinical practice.A parada cardiorrespiratória (PCR) é uma emergência médica que requer intervenção imediata e eficaz na sala de emergência. Protocolos bem definidos são essenciais para otimizar os resultados dos pacientes. Uma revisão sistemática foi conduzida de acordo com as diretrizes do PRISMA. A busca abrangente de literatura incluiu bases de dados eletrônicas e referências relevantes. Foram incluídos estudos que abordavam protocolos de PCR na sala de emergência, com avaliação da qualidade metodológica e extração de dados. A análise dos estudos incluídos revelou uma variedade de abordagens em protocolos de PCR, destacando tanto pontos de concordância quanto discordância entre as diretrizes internacionais. A integração de estratégias de ressuscitação, como manejo da temperatura pós-PCR e síndromes coronárias agudas, foi discutida em relação aos desafios e oportunidades na prática clínica. Esta revisão sistemática fornece uma síntese abrangente das evidências atuais sobre protocolos de PCR na sala de emergência, destacando a importância da implementação de diretrizes atualizadas e da identificação de lacunas para orientar futuras pesquisas e melhorias na prática clínica

The Importance Of Neuronal Plasticity In The Prognosis Of Cases Of Cerebral Ischemia: A Systematic Review

Background: Neuronal plasticity is the capacity that the neurons have to make new connections and enable new ways of transmitting information. Under this context, new methodologies are being addressed in order to measure how important this neuronal capacity is in the process of full recovery of learning in subjects who suffered damage from cerebral ischemia.Methods: A systematic review was performed on the online databases: Medical Literature Analysis and Retrieval System Online (MEDLINE) and Scopus, between 1998 and 2014. The MeSH (Medical Subject Headings) descriptors used in this review were: "neuronal plasticity", "brain ischemia" and "learning". We found 164 articles that, when screened, resulted in 46 articles that met the criteria of evidence and were included in this review.Results: There are several ways available in the literature to increase neuronal plasticity to keep the learning process after bad conformations resulting from cerebral ischemia. We highlighted the most elucidated: those promoted by SMe1EC2 antioxidant, which brings therapeutic benefits when neuronal plasticity is impaired; and Atorvastatin, a statin which facilitates recovery of spatial learning. It is further observed that the body has a number of intrinsic devicessuch as the endogenous compensatory mechanisms that contribute to the development of neuronal plasticity when there is brain damage caused by ischemia.Conclusion: The improvement of neuronal plasticity appears in several studies mapped as a new and still little explored possibility of treatment of damages caused by brain processes of oxygen deprivation. Multiple devices, endogenous and exogenous, that promote an increase in neuronal plasticity, are being elucidated in an attempt to promote the full recovery of the learning process, decreased by brain damage from ischemic processes. Thus, it is pointed the necessity of scientific studies that allows to define and maximize the potentials of the neuronal plasticity

Avanços da cirurgia robótica no tratamento de doenças cardiovasculares

Várias cirurgias médicas já utilizaram a tecnologia robótica, tais como: cirurgias no estômago, bexiga, rins, próstata, cérebro e inclusive no coração, o qual proporciona-se a reparação de válvulas cardíacas e até mesmo cirurgias nas artérias. O principal objetivo do presente estudo é discutir por meio da literatura científica acerca dos avanços da cirurgia robótica no tratamento de doenças cardiovasculares. Trata-se de uma revisão sistemática da literatura, dos quais, utilizou-se as bases e biblioteca eletrônica Scielo e Periódico Capes, totalizando 5 artigos elegíveis. A cirurgia robótica tem sido um dos principais métodos utilizados em tratamentos cardiovasculares quando comparados com técnicas convencionais, sobretudo, no que diz respeito, a cirurgia de revascularização do miocárdio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Neuroproteção na ressecção cirúrgica de gliomas cerebrais: revisão da evidência atual

Os gliomas cerebrais são tumores primários do sistema nervoso central que se desenvolvem a partir de células gliais e têm alta morbimortalidade. Seu tratamento padrão envolve a ressecção cirúrgica, radioterapia e quimioterapia, os quais possivelmente podem levar os pacientes a um prognóstico desfavorável. Nesse contexto, a neuroproteção entra como uma aliada para minimizar os efeitos colaterais da ressecção cirúrgica e melhorar a sobrevida e a qualidade de vida dos pacientes. Nesse sentido, o presente estudo tem como objetivo discutir sobre a evidência atual da neuroproteção na ressecção cirúrgica de gliomas cerebrais. Para isso, foram selecionados quatro artigos que que abordavam sobre a evidência atual da neuroproteção na ressecção cirúrgica de gliomas cerebrais, por meio de uma estratégia de busca com recorte temporal entre 2014 e 2023, nas bases de dados PubMed (Medline), Embase e Cochrane Library. Os resultados indicam que o grupo de pacientes que recebeu dexmedetomidina apresentou melhora significativa na cognição e redução da inflamação cerebral em comparação com o grupo-controle pós-ressecção dos gliomas cerebrais, além de menor incidência de efeitos colaterais anestésicos, como náusea e vômitos (p < 0,05). Ademais, foi observado que a modulação da via metabólica do glutamato/glutamina pode inibir o crescimento de gliomas e proteger o parênquima cerebral. Nesse sentido, as evidências atuais indicam que proteger as células nervosas é uma estratégia importante para minimizar os efeitos colaterais da ressecção cirúrgica de gliomas cerebrais, e a dexmedetomidina e a co-cultura de células de glioma e astrócitos que aumenta a concentração extracelular de glutamato e glutamina parecem ser importantes aliadas nessa profilaxia

Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost